Creutzfeldt-Jakob disease(CJD) is characterized clinically by rapidly progressive dementia with pyramidal, extrapyramidal, and cerebellar symptoms and signs, and histologically by spongiform change, neuronal loss and reactive gliosis. We have experienced 2 cases of CJD. Case 1 was a 36-year-old male who had suffered from myoclonus and cerebellar symptoms including sluggish speech, gait and balance disturbance. Case 2 was a 70-year-old female who had showed cognitive dysfunction, ataxic gait and disturbance of extraocular movement. Both patients, underwent brain biopsy. Case 1 revealed marked cortical atrophy, 2mm in thickness, with neuronal loss and astrocytic proliferation extending into white matter. The spongiform change, made up of many small, usually rounded or oval, vacuoles was noted mainly in the neuropil. Case 2 revealed remarkable spongiform change throughout the cortex and cytoplasmic vacuoles compressing the nuclei of neuronal cells were numerous. Neuronal loss and gliosis were also found without considerable change in the white matter. On double immunostaining against GFAP and PrP(Prion Protein), there was a weak positive reaction for PrP in the perinuclear cytoplasm in case 1, and a strongly positive reaction in case 2. The electron microscopic examination showed numerous membrane-bound vacuoles in neuropil and perikarya of neurons. The majority of the vacuoles were multiseptated by thin membranous structures. They demonstrated curled, or disrupted membrane, that had foldings and protrusions into the vacuolar clear spaces. There were neither identifiable virus-like particles nor amyloid deposition.
Female ; Male ; Humans

PURPOSE: The present study examined the possibility of standardization of medical education in three Asian countries-Korea, China, and Japan, by comparing their medical education and licensing systems. METHODS: As the criterion for comparison, we divided medical education system into three stages- basic medical education, graduate medical education, and continuing medical education. In addition, we analyzed the history and social and cultural backgrounds of medical education in each country. Recent changes were also examined. RESULTS: While little difference was found in the medical curriculums and courses between Korea and Japan, China's differed significantly from these two countries. But all three countries do attempt to keep up with international standards. CONCLUSION: To improve the quality of medical education in Korea, China, and Japan, these three countries need a plan to standardize medical education compatible with international standards but one that differs from western medical education by incorporating traditional medicine.
Asian Continental Ancestry Group ; China* ; Curriculum ; Education, Medical* ; Education, Medical, Continuing ; Education, Medical, Graduate ; Humans ; Internationality ; Japan* ; Korea* ; Licensure ; Medicine, Traditional ; Schools, Medical

Since the last 100 years, physicians from many countries have been taking collective action. However, the media, civic groups, and the government have denounced them as inhuman and unethical. This study comprehensively analyzed the background and results of physicians’ collective actions that occurred in countries around the world, and reviewed the issues surrounding them. Among 314 cases in 70 countries discussed in the literature, 180 cases in 65 countries were analyzed. Of these 180 cases, 111 (61.7%) were successful, indicating that collective action has brought favorable results to physicians. Furthermore, 177 out of 301 requirements brought favorable results (58.8%). The main reason for collective actions was ‘improvement of working conditions’, which includes improving the medical and the reimbursement systems, adjusting working hours and wages, increasing manpower, supporting medical research, and improving other working environment and conditions. This study is significant because it provides statistical data on the causes and results of collective actions taken by physicians in countries around the world.

PURPOSE: This study was done to identify the level of stress, hardiness, and professional burnout of intensive care unit (ICU) nurses and to provide basic data for the qualitative improvement of nursing work achievement in the workplace. METHOD: The data were obtained from 129 ICU nurses through a questionnaire. RESULTS: Stress showed positive correlation with the level of professional burnout and there was negative correlation between hardiness and professional burnout. Nurses in the group with a high level of stress, and a high level of hardiness reported a low level of professional burnout compared to those in the group with a lower level of hardiness (t=-2.60, p= .012). Nurses in the group with a low level of hardiness and a low level of stress showed a lower level of professional burnout than those with a high level of stress (t=3.51, p= .001). CONCLUSION: The results show that the high level of stress when coupled with a low level of hardiness of ICU nurses results in a high level of professional burnout. For this reason, it is important for nursing administration to support nurses to reduce levels of stress and the resulting burnout in ICU nurses.
Burnout, Professional* ; Intensive Care Units* ; Critical Care* ; Nursing ; Questionnaires

PURPOSE: The objectives of this study were: 1) to analyze Clinical Performance Examination(CPX) items using item response theory(IRT) and classical test theory(CTT) and 2) to discuss how to apply and interpret these results in order to improve the quality of CPX items. In addition, we intended to explore statistical procedures in order to merge examination data from several different medical schools. METHODS: The subject of the study was the 2005 CPX examination data from 10 medical schools located in Seoul and the Kyunggi province. For merging data from ten different medical schools, Levene's test for homogeneity of variances was used. Homogeneous group selection was conducted based on ANOVA or Kruskal-Wallis' test and Tukey's multiple comparisons appropriately. The generalized partial credit model was applied to analyze polytomous items and the 2-parameter logistic model was used to analyze dichotomous items. RESULTS: Data from 8 medical schools were incorporated into the analysis. The result of the discrimination index by IRT was different from that of CTT in both polytomous and dichotomous items. Discrimination index from IRT tended to be lower than that of CTT. Difficulty index of dichotomous items of two models was correlated well with each other. However, for polytomous items, IRT model provided more information than CCT. CONCLUSION: We discovered that the CPX items were mostly easy in terms of difficulty index, and the result from IRT and CCT model did not correlated well in the discrimination index. IRT may provide more detailed information for polytomous items, but the checklist and criteria of scoring system should be cautiously reviewed.
Checklist ; Discrimination (Psychology) ; Gyeonggi-do ; Logistic Models ; Schools, Medical ; Seoul

PURPOSE: Atherosclerotic vascular disease (AVD) is a leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD) on peritoneal dialysis (PD). Transforming growth factorbeta 1 (TGF-beta1) is a multifunctional cytokine that inhibits the atheromatous process. The author studied polymorphisms of the TGF-beta1 gene (-509C>T and 869T>C) as genetic susceptibility factors for AVD in PD patients. METHODS: Genotyping was carried out using the LightCycler 480 with melting curve analysis function. Prevalent vascular disease was defined by the presence of ischemic heart disease (IHD), peripheral vascular disease (PVD), cerebrovascular disease (CVD), or congestive heart failure (CHF). The presence of AVD was derived by the presence of any vascular disease (i.e., any degree of IHD/PVD/ CVD). RESULTS: In total, 109 PD patients were recruited (38.7% male, and 28.7% diabetic). The mean age was 49.1+/-14.1 years, and mean dialysis duration was 61.3+/-34.1 months. The most frequent genotype at -509C>T was CT (49.5%) and at 869T>C was TC (47.7%). No significant differences were observed in the genotype distributions of the investigated TGF-beta1 (CC:CT:TT, 18.5%:55.6%:25.9% vs 26.8%:47.6%:25.6%, Chi2=0.246, p=0.884; TT:TC:CC, 18.5%:55.6%:25.9% vs 28.0%:45.1%:26.8%, Chi2=1.188, p=0.552) between AVD group and no AVD group. CONCLUSION: TGF-beta1 gene polymorphisms at both -509C>T and +869T>C were not associated with an increased risk for prevalent vascular diseases. Further studies are required to evaluate the role of TGF-beta1 as a candidate gene.
Atherosclerosis ; Dialysis ; Freezing ; Genetic Predisposition to Disease ; Genotype ; Heart Failure ; Humans ; Kidney Failure, Chronic ; Male ; Mortality ; Myocardial Ischemia ; Peripheral Vascular Diseases ; Peritoneal Dialysis* ; Polymorphism, Genetic ; Transforming Growth Factor beta1 ; Vascular Diseases*

OBJECTIVE: Diabetic nephropathy is one of leading causes of end stage renal disease(ESRD). The ability to control anemia and hypertension without sudden drastic body fluid changes was thought to favor CAPD over hemodialysis for the management of diabetic ESRD with severe cardiovascular disease. To assess survival and risk factors in diabetic end stage renal failure, clinical studies were carried out on the 68 cases on CAPD who had been treated from January 1988 to February 1997. Methods - The mean age was 55.5 years and the sex distribution was 43 males to 25 females. Mean CAPD duration was 16.4 months ranged from one to 68 months. Five patients had insulin-dependent dia- betes ; 63 had non-insulin-dependent diabetes. Mean duration of diabetes was 13.8 years. All patients used curl catheter. Blood glucose was controlled by oral hypoglycemics(n=17) or subcutaneous regular insulin(n=51). Results - The incidence of peritonitis was 1.1 episodes/patient-year and exit site infection was 0.3 episodes/patient-year. Other complications were lea- kage, catheter dislodgement, transient hypotension. Mean hospital stay was 48.6 days/patient-year. Patient survival rates at 1, 2, 3, and 4 years were 73, 51, 30, and 30%, respectively for diabetic CAPD patients and 92, 85, 72, and 68%, respectively for non-diabetic patients. Diabetic CAPD patients had significantly lower survival when compare to nondiabetics(p<0.01). Catheter survival rates were 85% at one year, and 42% at three years in diabetics. Catheter were removed in 19 cases and the causes were peritonitis(84.2%) and catheter obstruction and malfunction(15.8%). By the end of the study, 38.2% of the patients were still on CAPD, 44.19% had died, 17.6M had transferred to hemodialysis. Common cause of deaths were cachexia, CAPD peritonitis with sepsis, cerebrovascular accidents and cardiovascular complications. CONCLUSION: Although diabetic CAPD patients had significantly lower survival compared to non-diabetics, CAPD seems a good renal replacement modality for patients with diabetic renal failure as yet.
Anemia ; Blood Glucose ; Body Fluids ; Cachexia ; Cardiovascular Diseases ; Catheter Obstruction ; Catheters ; Cause of Death ; Diabetes Mellitus ; Diabetic Nephropathies* ; Female ; Humans ; Hypertension ; Hypotension ; Incidence ; Kidney Failure, Chronic ; Length of Stay ; Male ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Renal Dialysis ; Renal Insufficiency ; Risk Factors ; Sepsis ; Sex Distribution ; Stroke ; Survival Rate

The prevalence of hemodialysis (HD) and peritoneal dialysis (PD) as a treatment modality for end-stage renal disease (ESRD) varies among countries and is affected by non-clinical factors including insurance, the health care system, and the preferences for treatment providers rather than clinical factors. There are pros and cons to both modalities. So far, since no randomized controlled trials have succeeded in revealing which dialysis modality is better, knowledge on clinical outcomes in patients with ESRD by dialysis modality is based on the results from multicenter prospective observational studies and large-scale national registry data in each country. In prospective cohort studies in the 1990's, HD showed similar or higher mortality than PD during the first year, but PD showed higher mortality after the first year. Meanwhile, clinical outcomes of dialysis patients resulting from national registry data in the 1990's were similar for PD and HD. From national registry data after 2000, the survival of patients on both HD and PD improved rapidly. This improvement was much greater in PD, especially in the early period after initiation of dialysis. Non-diabetic patients less than 65 years old showed better outcomes with PD than HD, whereas diabetic patients aged more than 65 years old (especially females) showed better outcomes with HD than PD. A higher risk of death in diabetic PD patients, though still present in the most recent cohorts, has been progressively attenuated over time in recent cohorts.
Aged ; Cohort Studies ; Delivery of Health Care ; Dialysis ; Humans ; Insurance ; Kidney Failure, Chronic ; Peritoneal Dialysis ; Prevalence ; Prospective Studies ; Renal Dialysis

PURPOSE: To report two cases of nasal type Natural Killer (NK)/T-cell lymphoma of the orbit. METHODS: (Case 1) A 42-year-old woman presented with a 3-month history of painful proptosis and eyelid swelling in the right eye. Under the diagnosis of inflammatory pseudotumor, she was treated with intravenous and oral steroids. She visited our clinic with a 3-day history of proptosis with decreased visual acuity. Computed tomography (CT) revealed a large infiltrative mass in the right orbit. Incisional biopsy was performed in the right lower lid. (Case 2) A 42-year-old man was referred for consultation with a 1-month history of fever of unknown origin. Two months previously uveitis had developed in the right eye and had been treated with topical steroid. CT revealed an infiltrative soft-tissue like mass in the left orbit. Incisional biopsy was performed in the orbital area. RESULTS: Histopathologically, a diffuse infiltration of atypical lymphocytes was observed with angiocentric pattern in both patients. The infiltrating cells were positive on immunohistochemical stains for CD3 and CD56. The tumor cells were negative for CD20 and CD30. In situ hybridization demonstrated Epstein-Barr virus-encoded nuclear RNA. A diagnosis was made with NK/T-cell lymphoma of nasal type associated with Epstein-Barr virus infection. CONCLUSIONS: NK/T-cell lymphoma of the orbit is rare and has poor prognosis. It is important to distinguish a NK/T-cell lymphoma from the pseudotumor or uveitis unresponsive to steroid therapy.
Adult ; Biopsy ; Coloring Agents ; Diagnosis ; Exophthalmos ; Eyelids ; Female ; Fever of Unknown Origin ; Granuloma, Plasma Cell ; Herpesvirus 4, Human ; Humans ; In Situ Hybridization ; Lymphocytes ; Lymphoma* ; Orbit* ; Prognosis ; RNA, Nuclear ; Steroids ; Uveitis ; Visual Acuity

BACKGROUND: The clinical manifestations of peritonitis in long-term PD patients may be more severe due to structural and functional alterations of the peritoneum caused by repeated exposure to the bioincompatible dialysate. However, the study in which outcome of peritonitis was compared to the duration of PD has been reported rarely. This study was performed to evaluate the effect of PD duration on the outcome of peritonitis. METHODS: Medical records of patients cared for in Kyungpook University Hospital between June 1998 and May 2001 were reviewed retrospectively. Patients were divided into three groups by PD duration: group 1, < or =12 months; group 2, 13-36 months; group 3, > or =37 months. RESULTS: There were 303 episodes (156 patients) of peritonitis during the study periods: 77 episodes in group 1, 115 episodes in group 2 and 111 episodes in group 3. There was no difference in gram- positive, gram-negative or fungal rate of peritonitis among three groups. In group 3, 16.2% of the patients transferred to hemodialysis, while 3.9% and 7.0% of patients in group 1 and 2 transferred to hemodialysis (p<0.05). CONCLUSION: Patients maintained on PD for over three years are associated with higher rate of technique failure than patients maintained on PD for less than three years. PD duration may be considered as a factor for predicting prognosis of peritonitis. Peritonitis in patients on long-term PD needs special attention.
Gyeongsangbuk-do ; Humans ; Medical Records ; Peritoneal Dialysis* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritoneum ; Peritonitis* ; Prognosis ; Renal Dialysis ; Retrospective Studies